Unlock your body’s potential
As a physical therapist, I often work with people who are in pain. Even though the immediate symptoms are different, there is usually an underlying problem: a lack of psychomotor control. This isn’t just about how strong or flexible a single muscle is; it’s about making the complex network of nerves and muscles that controls every movement work better. To really understand and address these problems, we need to examine more closely the basic ideas behind motor control and motor learning.
What is “Motor Control”?
It’s more than just moving muscles
“Motor control” is a term that is often used too broadly, sometimes meaning “motor output” or “muscle activity.” However, Levin and Piscitelli (2022), who study rehabilitation, stress that there is a big difference: motor control is not just the observable muscle forces or movements (motor output) [4].
Think of your body as a well-tuned orchestra. Every muscle has a job: the prime mover leads the song, the stabilizers keep the rhythm steady, and the synergists contribute harmony. Psychomotor control is basically about strengthening the connection between your mind and body so that you can improve your movements and help your muscles work properly.
If one musician tries to play another musician’s part, things get out of hand. For example:
- The Overworked Stabilizer: The Tensor Fasciae Latae (TFL) is an important hip stabilizer that helps keep your pelvis stable so your glutes can generate power. If the TFL mistakenly takes on the role of a prime mover, other muscles, such as the Quadratus Lumborum (QL), become overly heavy stabilizers. This can lead to common issues like soreness on the outside of the knee, inflammation of the IT band, or trochanteric bursitis.
- The Missing Prime Mover: Consider hip extension, a fundamental movement. Your glutes should be the primary engine. But if they are underused or only act as synergists, other muscles, like your hamstrings and paraspinals, compensate by becoming the main movers and pulling excessively on your lumbar spine. This unhealthy pattern can result in persistent back pain and hamstring strains that won’t go away, especially when you run.
The main goal of rehabilitation is to get these muscles back in sync. To do this, you need to know how the CNS really makes movement happen.
The brain’s plan with indirect control and referent theory
In the past, certain ideas (the “direct framework”) said that the CNS directly calculates and programs the exact muscle forces and EMG patterns needed for each movement. Nonetheless, this methodology encounters significant physiological and computational challenges, notably the “motor redundancy problem” – the extensive variety of ways a movement can be executed [4].
Levin and Piscitelli support a more physiologically sound method called the indirect framework, especially the referent control theory [4]. This concept states that the CNS does not directly control muscle forces. Instead, it generates movement by adjusting referent thresholds for muscle activation (known as Tonic Stretch Reflex Thresholds, or TSRTs, and Referent Body Configuration, or RC) [4]. You can think of it as establishing a “postural equilibrium point” you aim for. The body then moves to get as close as possible to this new referent configuration, considering biomechanical and environmental constraints [4]. This perspective suggests that the CNS uses the body’s natural redundancy and adaptability to find many acceptable solutions for a task, rather than relying on rigid, pre-set patterns.
How we learn to move better
Different ways our bodies learn to move
Motor learning, defined as a persistent alteration in motor behavior, is not a singular, homogeneous process. Leech et al. (2022) assert that there exist a minimum of four separate systems facilitating motor learning, frequently operating concurrently or independently, each characterized by specific attributes and neurological substrates [5]. Knowing these things helps us plan interventions that really work.
Use-Dependent Motor Learning (Repetition-Based):
What it is: Better motor behavior that comes from doing the same activity over and over again [5]. Think about a golfer who swings the club over and over again.
How it works: This method depends on the plasticity of the central nervous system, which means that lots of practice causes structural and functional changes. The main reason it works is because of the amount of practice, and the learner has to put in effort and think about what they’re doing [5].
Clinical Relevance: Important for forming new movement habits and making them more automatic. It’s a key part of recovery, but it can take a long time to see lasting changes.
Strategy-Based / Explicit Instructive Motor Learning:
What it is: Changes in how a person moves that are caused by planned movement strategies, frequently in response to particular external feedback (such verbal or visual cues) regarding how well they are doing compared to a task goal [5].
How it works: This requires higher-level thinking and is mostly controlled by the prefrontal cortex. The student comprehends and can recollect the method for minimizing errors [5].
Clinical Relevance: Helpful for quick, short-term benefits, especially when cognition is still good. Clinicians often provide patients verbal cues and directions to help them.
Reinforcement Motor Learning (Reward-Based):
What it is: Changes in motor behavior caused by binary, outcome-based feedback (like success/failure) [5].
How it works: The basal ganglia are thought to be important, and dopamine signaling depending on rewards may help choose successful movements. It promotes the investigation of various movements to achieve effective results [5].
Clinical Relevance: Encourages patients and helps them make good choices. Can lead to long-term changes in behavior, but usually not as quickly as learning through instruction.
Sensorimotor Adaptation (Recalibration / Implicit):
What it is: Changes in motor behavior caused by sensory prediction errors, which happen when the actual sensory result of a movement doesn’t match the expected result (for example, when there is unexpected resistance) [5].
How it works: The cerebellum is mainly responsible for automatically adjusting motor commands to lower prediction mistakes. It’s often not said directly and happens quickly (in minutes to hours) [5].
Clinical Relevance: Important for adapting to unanticipated changes in the environment or the demands of the activity. Helps the body reset its internal models so that it can move smoothly.
The Central Pillar
Stabilizing the Core for Balance and Proprioception
The core is probably the most important part of this system for learning and controlling movement. It’s the major center of movement and the place where stability is kept. Core stability isn’t simply having strong abs; it’s also about how the deep trunk muscles work together, especially the transversus abdominis (TrA) and lumbar multifidus (LM), to give your limbs a secure basis. This dynamic stability is essential for the body to efficiently alter its referent configuration for mobility.
A new randomized controlled trial by Hlaing et al. (2021) elucidates the significance of targeted core stabilization exercises (CSE) for persons suffering with subacute non-specific low back pain (NSLBP) [3]. This study compared CSE to general strengthening exercises (STE) and found strong evidence:
Better Proprioception
The CSE group had a much more improvement in proprioception (the body’s ability to know where it is in space) than the STE group. This is important because many people with LBP have less proprioception in their lower back, which makes their movements change and their discomfort worse [3].
Better Balance
CSE also worked better to improve balance, especially while standing on one leg on both solid and unstable surfaces [3]. This means better functional movement and a lower danger of falling.
Targeted muscular Gains
Patients undergoing CSE demonstrated significant gains in the muscular thickness of their deep core muscles (Transversus Abdominis and Lumbar Multifidus), underscoring their essential function in spinal stability and sensory integration [3].
Less impairment and dread
Both types of exercise helped with pain, but CSE helped with functional impairment and dread of mobility more than the other type [3]. This shows how CSE can help in many ways, not just with physical symptoms but also with mental health issues that might slow down recovery.
These results show that specifically targeting these deep core muscles through CSE, which focuses on low-load activation and motor learning, is better than general strengthening for improving the complex relationship between sensory input, central processing, and motor output. This leads to better spinal control and less pain [3]. These exercises primarily utilize use-dependent motor learning (repetition of specific muscle activation patterns) and sensorimotor adaptation (refining proprioceptive feedback), and potentially reinforcement learning (success in reducing pain) to assist the CNS in better establishing and maintaining stable referent configurations for the trunk, thereby creating a reliable foundation for all other movements.
Specialized Techniques to Improving Motor Control with PNF and NJF
In addition to this central core stability, other specialized approaches improve movement patterns and neurological efficiency even more, changing the body’s referent thresholds in certain ways.
Proprioceptive Neuromuscular Facilitation (PNF)
You may have had PNF done in a clinic, where it is commonly used to help patients who have had soft tissue damage or surgery regain their functional range of motion (ROM) and strength [1]. PNF mostly works by using your body’s inherent reflexes to help you become more flexible and relaxed [1]:
Autogenic Inhibition: When you contract a muscle that is already stretched, sensory organs in the muscle (Golgi tendon organs) tell your nervous system to relax that muscle, which lets it stretch even further.
Reciprocal Inhibition: When you aggressively contract a muscle that is opposite to the one you want to stretch (for example, your quads to stretch your hamstrings), your neural system tells the muscle you want to stretch to relax, which makes it easier to stretch.
Stress Relaxation and Gate Control: These systems also help by encouraging tissue lengthening over time and controlling pain signals, respectively [1].
From the referent control standpoint, PNF approaches, by engaging specific muscle contractions and stretches, successfully assist the CNS in “re-calibrating” the referent thresholds for muscle activation, hence enabling a broader feasible range of motion (ROM) and promoting more flexible movement solutions. PNF mainly uses sensorimotor adaptation by changing the length and tension of muscles and use-dependent learning by doing the same stretch-contraction cycles over and over [1].
PNF for Performance: Timing is Key
The advantages of PNF are evident: augmented range of motion, enhanced muscle strength, and superior athletic performance. But when you do PNF is very important for getting the most out of these benefits and not getting any unwanted side effects [1]:
After Exercise or Independently: PNF works very well to improve ROM, strength, and overall athletic performance whether done after exercise or as a separate flexibility session. It is important to be consistent; doing PNF at least twice a week can help you keep your gains.
Avoid Before Maximal work: If you’re about to do something that requires a lot of muscle work, like sprinting, plyometrics, or heavy weightlifting, doing PNF first can actually make you perform worse for up to 90 minutes.
Studies also show that you don’t always have to give it your best, which is interesting. Submaximal contractions (e.g., 20-60% of your maximum voluntary isometric contraction) during PNF can be equally efficient for improving flexibility as maximal contractions, potentially making it safer and more accessible for varied individuals [1].
Neuromuscular Joint Facilitation (NJF): Accuracy for Reaction Time
PNF is great for developing range of motion and general muscle function, but sometimes we need to focus on the speed and efficiency of muscle activation, which is especially important for quick, reactionary movements. This is where Neuromuscular Joint Facilitation (NJF) comes in.
NJF is a new way to perform therapeutic exercises that combines the facilitation components of PNF with motions specific to the joint’s composition [2]. It seeks to enhance joint mobility with passive, active, and resistance exercises, similar to PNF, but with an intensified emphasis on the joint itself [2].
A significant study conducted by Huo et al. (2013) elucidated a crucial distinction between NJF and conventional PNF. Their study focused on the immediate effects of both approaches on electromechanical reaction times (EMG-RT) during hip flexion. The findings demonstrated[2]:
- Faster Neural Response: After the intervention, the NJF group had a substantial decrease in both EMG-RT and PMT, which suggests that their arousal levels, attention, and the speed at which signals travel from the brain to the muscle all improved. This means that it’s easier to move referent thresholds quickly.
- Targeted Joint Mechanics: The study pointed out that NJF focuses on the rotation function of the “caput femoris” (the head of your thigh bone) and uses proximal resistance on the greater trochanter. This focused method of studying how the hip joint works seems to be the key to making reaction times faster [2].
- PNF’s Role: In this study, the PNF group did not exhibit any immediate alterations in these specific response time metrics [2].
This suggests that NJF might be more effective than PNF for enhancing the speed and neurological efficiency of specific joint movements, such as hip flexion. PNF excels in improving overall flexibility and general strength. For athletes who need to change directions rapidly or older individuals at risk of falling and requiring quicker protective responses, enhancing electromechanical reaction time through NJF could be significantly beneficial. NJF likely employs sensorimotor adaptation, use-dependent learning, and possibly instructive learning via precise guidance to help the CNS establish referent thresholds for quick motions more swiftly and accurately.
Putting It All Together
The Whole-Person Approach Based on Motor Control Theory and Motor Learning Principles
A thorough understanding of motor control theory and the many ways that people learn to move helps us plan our treatments. We don’t only cure symptoms; we want to retrain the CNS to develop better, more flexible ways to control movement. This involves encouraging motor learning, which isn’t about memorizing strict muscle activation patterns. Instead, it’s about finding stable and productive ways to move by using the body’s natural redundancy [4].
For instance, a person with low back discomfort and poor balance can benefit from Core Stabilization Exercises (CSE) to help them activate their deep core muscles and enhance their lumbar proprioception. This mainly uses use-dependent learning and sensorimotor adaptation to assist the CNS set up more stable referent configurations for the trunk. After this central stability is improved, we may employ PNF to fix any lingering flexibility problems in the hamstrings or hips. This helps the CNS successfully reset the referent thresholds for limb movements, which increases functional ROM through sensorimotor adaptation and use-dependent learning.
If that patient is an athlete who needs to react quickly, NJF could be used to improve the speed and accuracy of certain joint movements, like hip flexion, by making it easier for local referent thresholds to change quickly, again through sensorimotor adaptation and use-dependent learning, often with instructive feedback.
Players can’t always think about how to activate each muscle during dynamic play. Still, it’s important to lock in these basic concepts in controlled conditions so that performance may improve over time and injuries can be avoided. By smartly using motor learning principles, we help the CNS set the right referent thresholds and take use of the body’s inherent tendency to adapt, going beyond just treating symptoms.
In the end, we give you the tools you need to move more easily, powerfully, and confidently by using a comprehensive motor control framework and evidence-based techniques like CSE, PNF, and NJF, which are grounded in the different ways people learn to move. This lowers your risk of injury and improves your overall performance and quality of life.
Sources
- Hindle KB, Whitcomb TJ, Briggs WO, Hong J. Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function. J Hum Kinet. 2012;31:105–113.
- Huo M, Wang H, Ge M, Huang Q, Li D, Maruyama H. The Immediate Impact of Neuromuscular Joint Facilitation (NJF) Treatment on Electromechanical Reaction Times of Hip Flexion. J Phys Ther Sci. 2013;25(11):1463–1465.
- Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization and strengthening exercises on proprioception, balance, muscle thickness, and pain-related outcomes in individuals with subacute nonspecific low back pain: a randomized controlled experiment. BMC Musculoskeletal Disorders. 22(1):998 in 2021.
- Levin MF, Piscitelli D. Motor Control: A Theoretical Framework for Rehabilitation. Motor Control. 2022;26(4):497–517.
- Leech, Roemmich, Gordon, Reisman, and Cherry-Allen wrote a paper called “Updates in Motor Learning: Implications for Physical Therapist Practice and Education.” Phys Ther. 2022;102(1):1–9.